Topical clobetasol propionate 0.05% cream alone and in combination with azathioprine in patients with chronic hand eczema: An observer blinded randomized comparative trial

Agarwal, Uma Shankar; Besarwal, Raj Kumar

doi:10.4103/0378-6323.104679

Cited by 31 publications

(28 citation statements)

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“…Azathioprine is not registered for HE but is frequently prescribed off‐label for HE. One single‐blind RCT including 108 participants, compared treatment with topical clobetasol vs clobetasol plus azathioprine 50 mg/day 183 . Although the HECSI was used as an outcome, baseline HECSI scores were not reported.…”

Section: Treatmentmentioning

confidence: 99%

Guidelines for diagnosis, prevention, and treatment of hand eczema

et al. 2022

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Funding informationNo support was given by any medical company for development of this document. All meetings were virtual meetings, therefore there were no costs. All participants in the working group filled in a structured form to declare financial or non-financial interests. Disclosures are given in the Supporting information. The Guidelines were approved by the executive committee of the ESCD in

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Section: Treatmentmentioning

confidence: 99%

Guidelines for diagnosis, prevention, and treatment of hand eczema

et al. 2022

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“…Azathioprine causes accumulation of 6‐thioguanine nucleotides in lymphocytes, which inhibits expression of endogenous inflammatory mediators, such as TNF‐related apoptosis‐inducing ligand, TNF receptor superfamily member 7, and α4‐integrin (Levy, Barnett, MacDonald, Klinenberg, & Pearson, ; Thomas et al, ). Additionally, azathioprine induces T‐cell apoptosis, specifically of CD45RO memory T‐lymphocytes, suggesting that it may be helpful in treating the ACD subtype of CHE (Agarwal & Besarwal, ; Tiede et al, ). In an observer‐blinded, randomized control trial of 91 patients diagnosed with CHE >6 months, clobetasol propionate 0.05% cream in combination with azathioprine 50 mg daily led to significantly higher mean percent improvement in HESCI at 24 weeks than clobetasol alone (92 vs. 65%, p = 0.001; Agarwal & Besarwal, ).…”

Section: Systemic Agentsmentioning

confidence: 99%

“…Additionally, azathioprine induces T‐cell apoptosis, specifically of CD45RO memory T‐lymphocytes, suggesting that it may be helpful in treating the ACD subtype of CHE (Agarwal & Besarwal, ; Tiede et al, ). In an observer‐blinded, randomized control trial of 91 patients diagnosed with CHE >6 months, clobetasol propionate 0.05% cream in combination with azathioprine 50 mg daily led to significantly higher mean percent improvement in HESCI at 24 weeks than clobetasol alone (92 vs. 65%, p = 0.001; Agarwal & Besarwal, ).…”

Section: Systemic Agentsmentioning

confidence: 99%

Current and emerging therapies for hand eczema

Lee

Maarouf

Hendricks

et al. 2019

Dermatologic Therapy

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Although hand eczema (HE) and chronic hand eczema (CHE) are common conditions with significant disease burden, they traditionally have had limited treatment options beyond topical and short‐term systemic corticosteroids. We reviewed published and preliminary evidence on the current and emerging topical and systemic therapeutic agents for HE and CHE. The etiologies of various HE subtypes are discussed, and remaining knowledge and practice gaps are highlighted to encourage further investigations. A comprehensive search of http://clinicaltrials.gov and PubMed was completed for clinical trials that utilized known and emerging treatment options for HE and CHE. Several agents that target IL‐4 and IL‐13 signaling, keratinocyte proliferation, inflammatory cytokine production, bacterial protein synthesis, and inflammatory mediator (TNF‐α, JAK1, JAK2, and JAK3) proliferation are shown to be involved in the pathogenesis of CHE. Systemic agents include dupilumab, alitretinoin, acitretin, cyclosporine, azathioprine, and probiotics. Topical agents include delgocitinib, retapamulin, halometasone/triclosan, calcipotriol/betamethasone, tacrolimus, and pimecrolimus. These modalities have demonstrated varying degrees of clinical efficacy, evaluated by subjective assessments and scoring indexes. Targeted therapies are emerging for HE, but options are still limited, partially due to our narrow understanding of this heterogeneous condition. Additional and targeted therapeutic options are needed to match the rising prevalence and burden of HE. Keypoints Hand eczema (HE) is a heterogenous dermatosis with limited therapeutic options due to a lack of international guidelines regarding classification of HE subtypes and treatment. This review discusses current and emerging topical and systemic agents and their efficacies in the treatment of different types of hand eczema.

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“…About one‐third of patients with atopic dermatitis have a good response, typically after about 6 months 58 . In an observer‐blinded, randomised controlled trial in 91 patients with chronic hand eczema, clobetasol propionate 0.05% cream in combination with azathioprine 50 mg daily led to significantly higher mean per cent improvement in the Hand Eczema Scoring Index (HESCI) at 24 weeks than clobetasol alone (92% vs. 65%, P = 0.001) 80 . In a drug survival study in 30 patients with chronic hand eczema, half discontinued azathioprine in the first 3 months because of adverse effects, but 7 of the 15 patients who continued azathioprine for 3 months remained on therapy at 1 year 81 .…”

Section: Systemic Therapiesmentioning

confidence: 99%

Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative

et al. 2020

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Chronic hand/foot eczemas are common, but treatment is often challenging, with widespread dissatisfaction over current available options. Detailed history is important, particularly with regard to potential exposure to irritants and allergens. Patch testing should be regarded as a standard investigation. Individual treatment outcomes and targets, including systemic therapy, should be discussed early with patients, restoring function being the primary goal, with clearing the skin a secondary outcome. Each new treatment, where appropriate, should be considered additive or overlapping to any previous therapy. Management extends beyond mere pharmacological or physical treatment, and requires an encompassing approach including removal or avoidance of causative factors, behavioural changes and social support. To date, there is little evidence to guide sequences or combinations of therapies. Moderately symptomatic patients (e.g. DLQI ≥ 10) should be started on a potent/super‐potent topical corticosteroid applied once or twice per day for 4 weeks, with tapering to twice weekly application. If response is inadequate, consider phototherapy, and then a 12‐week trial of a retinoid (alitretinoin or acitretin). Second line systemic treatments include methotrexate, ciclosporin and azathioprine. For patients presenting with severe symptomatic disease (DLQI ≥ 15), consider predniso(lo)ne 0.5–1.0 mg/kg/day (or ciclosporin 3 – 5 mg/kg/day) for 4–6 weeks with tapering, and then treating as for moderate disease as above. In non‐responders, botulinum toxin and/or iontophoresis, if associated with hyperhidrosis, may sometimes help. Some patients only respond to long‐term systemic corticosteroids. The data on sequencing of newer agents, such as dupilumab or JAK inhibitors, are immature.

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Topical clobetasol propionate 0.05% cream alone and in combination with azathioprine in patients with chronic hand eczema: An observer blinded randomized comparative trial

Cited by 31 publications

References 0 publications

Guidelines for diagnosis, prevention, and treatment of hand eczema

Guidelines for diagnosis, prevention, and treatment of hand eczema

Current and emerging therapies for hand eczema

Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative

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